Major public insurance reforms of the past two decades, i.e., those requiring enrollment into managed care programs, have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older, who suffer from poorer quality of life and lower life expectancies compared to all other aging populations in the U.S. American Indian elders represent a neglected group within the nation's healthcare system. Despite the pervasive belief that the Indian Health Service (IHS) will fully address their health-related needs, elders are negatively affected by gaps in insurance and lack of access to healthcare. Since 2014, the Patient Protection and Affordable Care Act, plus state Medicaid expansion, has made it possible for American Indian elders who are not yet eligible for Medicare to benefit from healthcare coverage. The Affordable Care Act is also intended to improve access to and quality of services for seniors in Medicare and includes special provisions to ameliorate healthcare disparities for American Indians. This proposed five-year, community-driven study features a mixed-method, participatory research design to examine insurance-related outreach activities under the Affordable Care Act, help-seeking behavior, and the healthcare experiences of American Indian elders in New Mexico, home to 22 federally-recognized Pueblos and Tribes. This study combines qualitative and quantitative interviews with concept-mapping techniques and focus groups. The information gathered will generate new practical knowledge, grounded in the actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will also inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of healthcare by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on the AIE population, and will offer a replicable model for enhancing the effects of the Affordable Care Act on other underserved groups affected by inequities in healthcare.